Dr Jim Brooker
Dr Tony Smith and Dr Jim Brooker review the Pillcam ‘video’
Jim Brooker was there from the start.
Back in the 1990s he was a registrar in London when the professor he worked for began developing a remarkable technology that would take medicine on a voyage through inner space. Today Dr Brooker is using that technology on a weekly basis at Braemar Hospital in Hamilton.
The PillCam is a capsule the size of a vitamin pill which passes through the patient’s digestive system, taking around 60,000 pictures along the way. Where it really counts is on its journey through the six to eight metres of the small intestine, part of the body that can otherwise only be accessed by opening the patient up. The capsule endoscopy procedure makes diagnosis of ailments safe, simple and comfortable for the patient.
Jim Brooker, who is now a gastroenterologist, watched first hand in his native UK as the ingenious technology was developed. “I was able to observe what was going on and the tremendous excitement. This technology revolutionised our ability to see into the small intestine.”
It was natural, then, that when he migrated to New Zealand in 2003 he would push for its use in the Waikato. Three years later, the procedure was being done at Braemar.
From a patient’s point of view, it could hardly be easier. A belt with a data recorder is strapped to their waist and they swallow the pill, which has its own light source and camera. It is propelled by the digestive system’s own action and as it does so takes two pictures per second, with a field of view of 140 degrees. Those images are transmitted to a data recorder on the belt which the patient wears for eight hours.
By then the pill has done its work, and it’s up to Dr Brooker to examine the results – a process which can take up to an hour and a half. On his computer screen, he views what is in effect a video of the intestine, in incredible detail. The capsule, which weighs less than 4 grams, enables the detection of objects less than 0.1mm. It enables Dr Brooker to check for abnormalities such as tumours or the signs of illnesses like Crohn’s disease and Celiac disease. A colleague also views the video and then they collaborate on a report. Fortunately, he says, serious conditions of the small intestine are uncommon.
As for the pill itself, it is later excreted naturally and often, says Dr Brooker, kept by the patient as a memento. “It has no value once it’s passed through the system; it’s a single use item. Patients either use it as a trophy – or some of the technically minded ones will dismantle it and find out how it works.”
Dr Brooker does both endoscopy and colonoscopy. They are mostly diagnostic procedures, though there is some therapeutic work, including removing polyps.
But, maybe by way of compensation, when he’s not investigating inner space through the extraordinary technology that’s available, he’s enjoying the wide open spaces of the Waikato.
That means you might see him cycling around the roads of the Waikato in preparation for the Lake Taupo Challenge, or in the bush with his four children, aged eight to fourteen, who are enthusiastic members of the Junior Naturalists Club. He is on the club’s committee, enjoying the chance to explore the bush with likeminded people.
“I love New Zealand, I love the outdoor life, and I think it’s a healthier environment for the children than back in the UK.”
5 Commonly Asked Questions:
1) Why do I need a Pillcam test?
The Pillcam is specifically designed to look for small bowel problems, especially those causing bleeding, anaemia or inflammation, and occasionally to search for rare tumours in this part of the gut. Before the Pillcam test, in most cases, a patient will already have had the more readily accessible parts of the digestive system (oesophagus, stomach, duodenum and colon) examined by conventional endoscopy. There are alternative ways of examining the small bowel with X-ray techniques, and occasionally these are still performed instead of or as well as a Pillcam. The exact choice and order of the tests depends on the medical problem under investigation.
2) Am I going to be able to swallow the Pillcam?
The Pillcam is the size of a large vitamin tablet, it is very smooth and slippery when wet, and it is taken with a glass of water. Patients do occasionally have difficulty getting it down especially if they have a pre-existing swallowing problem. In the unusual event that the capsule cannot be swallowed we can deliver it directly to the stomach with the aid of an endoscopy. It is important to inform your specialist and the nurse performing the Pillcam test of any problems that you have with swallowing.
3) Could it get stuck in the intestine?
If there is a narrowing in the small intestine the Pillcam may become stuck. This is very uncommon (less than 5%), but if it should happen the capsule must be removed, usually requiring surgery. The capsule’s outer shell is very stable in the intestine and so it is safe to leave it there for several weeks if there is a chance that it will pass naturally. When a capsule becomes lodged, this always occurs at the site of an abnormality, so the answer to the medical question is usually revealed, and diagnosis and treatment are achieved by the operation to remove it. If we suspect that narrowings of the small bowel may be present (usually in patients with suspected Crohn’s disease or who take regular anti-inflammatory medication), we first give the small bowel a “trial run” using a dissolvable dummy Pillcam (the Agile [TM] patency test).
4) How long will it take to get my results?
The images from the test are saved on a data recorder and transferred to a computer workstation overnight. Over 60,000 pictures of the gut are generated and these are examined like a movie, using specially developed software. Two specialists independently scrutinise the results and then collaborate on a final report, then the results are passed on to the referring doctor. This whole process may take up to two weeks.
5) Might other tests be necessary?
The Pillcam is a “diagnostic test” with the ability to photograph abnormalities, but it cannot take tissue samples or give treatment. If a significant abnormality is found during the test then further procedures may be necessary to allow biopsy or deliver treatment. These may include scans, “enteroscopy” (using a special endoscope to pass deep into the small intestine) or even surgery.
